atc athletes :: The Athletic Training Center

First Name:
Last Name:
Date of Birth:
Address:
City:
State:
Zip:
Phone:
E-mail:
Height:
Weight:
Grade:
T-Shirt Size :
Name of School:
GPA:
Coachs Name:
Position:
Date of Physical:
Family Doctor:
	Do you have any medical conditions that may inhibit or prevent you from participating in any physical activities (such as irregular heartbeat, or shortness of breath)? Yes or No. If yes, please explain.

	Please list any major injuries, surgeries, & dates that have occurred within the past year.